Radiotherapy for cutaneous head and neck cancer and parotid tumours: a prospective investigation of treatment-related acute swallowing and toxicity patterns
- 96 Downloads
Reports of acute treatment-related dysphagia and toxicities for patients with parotid tumours or cutaneous head and neck cancer (HNC) are limited. This study aimed to describe the severity and timing of dysphagia and related toxicities experienced during radiotherapy for cutaneous HNC and parotid tumours, to inform the nature of future speech pathology (SP) service models required during treatment.
Prospective study of 32 patients with parotid tumours and 36 with cutaneous HNC undergoing curative non-surgical management. Dysphagia and acute toxicity data was collected weekly during treatment and at 2, 4 and 12 weeks post-treatment using the Functional Oral Intake Scale, diet descriptors and CTCAE v4.0.
In both groups, minimal treatment toxicities (grades 0–1) were observed. Xerostomia and dysgeusia were the most frequently reported grade 2 toxicities. Only 3% of parotid patients and 6% with cutaneous HNC experienced grade 3 dysphagia. Full or soft texture diets were maintained by > 70% of patients in both groups. Symptoms peaked in the final week of treatment and rapidly improved thereafter. Apart from xerostomia < 10% of patients had any grade 2 toxicity at 12 weeks post-treatment.
Patients in these subgroups of HNC experienced minimal treatment-related toxicity during radiotherapy. As such, the need for supportive symptom management by SP is low. Models that involve interdisciplinary surveillance of symptoms with referral to SP only when required may be best suited for these individuals to ensure issues are identified whilst minimising patient burden created by unnecessary routine SP appointments.
KeywordsDysphagia Toxicities Radiotherapy Parotid gland cancer Cutaneous head and neck cancer
The authors wish to acknowledge the multidisciplinary Head and Neck team at the Royal Brisbane and Women’s Hospital for their support of this project.
This work received funding from the RBWH Foundation Research Grant, 2014–2015.
Compliance with ethical standards
Ethical clearance was provided by the local Human Research Ethics Committee (approval number: HREC/13/QRBW/444).
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Australian Institute of Health and Welfare (2016) Skin cancer in Australia. AIHW, CanberraGoogle Scholar
- 4.O’Hara J, Ferlito A, Takes RP, Rinaldo A, Strojan P, Shaha AR, Rodrigo JP, Paleri V (2011) Cutaneous squamous cell carcinoma of the head and neck metastasizing to the parotid gland—a review of current recommendations. Head Neck 33(12):1789–1795. https://doi.org/10.1002/hed.21583 CrossRefPubMedGoogle Scholar
- 5.Al-Mamgani A, van Rooij P, Verduijn GM, Meeuwis CA, Levendag PC (2012) Long-term outcomes and quality of life of 186 patients with primary parotid carcinoma treated with surgery and radiotherapy at the Daniel den Hoed Cancer Center. Int J Radiat Oncol Biol Phys 84(1):189–195. https://doi.org/10.1016/j.ijrobp.2011.11.045 CrossRefPubMedGoogle Scholar
- 7.Nutting CM, Rowbottom CG, Cosgrove VP, Henk JM, Dearnaley DP, Robinson MH, Conway J, Webb S (2001) Optimisation of radiotherapy for carcinoma of the parotid gland: a comparison of conventional, three-dimensional conformal, and intensity-modulated techniques. Radiother Oncol 60(2):163–172. https://doi.org/10.1016/S0167-8140(01)00339-5 CrossRefPubMedGoogle Scholar
- 10.Al-Mamgani A, van Rooij P, Sewnaik A, Tans L, Hardillo JA (2012) Adenoid cystic carcinoma of parotid gland treated with surgery and radiotherapy: long-term outcomes, QoL assessment and review of the literature. Oral Oncol 48(3):278–283. https://doi.org/10.1016/j.oraloncology.2011.10.014 CrossRefPubMedGoogle Scholar
- 13.Bressan V, Stevanin S, Bianchi M, Aleo G, Bagnasco A, Sasso L (2016) The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: a systematic review. Cancer Treat Rev 45:105–119CrossRefGoogle Scholar
- 14.Al-Mamgani A, van Rooij P, Verduijn GM, Mehilal R, Kerrebijn JD, Levendag PC (2013) The impact of treatment modality and radiation technique on outcomes and toxicity of patients with locally advanced oropharyngeal cancer. Laryngoscope 123(2):386–393. https://doi.org/10.1002/lary.23699 CrossRefPubMedGoogle Scholar
- 15.De Sanctis V, Bossi P, Sanguineti G, Trippa F, Ferrari D, Bacigalupo A, Ripamonti CI, Buglione M, Pergolizzi S, Langendjik JA, Murphy B, Raber-Durlacher J, Russi EG, Lalla RV (2016) Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus statements. Crit Rev Oncol Hematol 100:147–166CrossRefGoogle Scholar
- 16.Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K (2013) The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters. Biomed Res Int 2013:1–12. https://doi.org/10.1155/2013/401261 CrossRefGoogle Scholar
- 17.Beetz I, Steenbakkers RJ, Chouvalova O, Leemans CR, Doornaert P, van der Laan BF, Christianen ME, Vissink A, Bijl HP, van Luijk P, Langendijk JA (2014) The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patient-rated xerostomia. Acta Oncol 53(5):597–604. https://doi.org/10.3109/0284186X.2013.831186 CrossRefPubMedGoogle Scholar
- 18.Patel S, Wang C, Mourad WF, Dhanireddy B, Patel R, Patel L, Kabarriti R, Young R, Concert C, Ryniak M, Wen B, Shasha D, Hu KS, Harrison LB (2014) Postoperative radiation therapy for parotid pleomorphic adenoma with close or positive margins: treatment outcomes and toxicities. Int J Radiat Oncol Biol Phys 90(1):S545–S545. https://doi.org/10.1016/j.ijrobp.2014.05.1654 CrossRefGoogle Scholar
- 19.Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA (1999) Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 45(3):577–587. https://doi.org/10.1016/S0360-3016(99)00247-3 CrossRefPubMedGoogle Scholar
- 20.Olivier KR, Brown PD, Stafford SL, Ansell SM, Martenson JA Jr (2004) Efficacy and treatment-related toxicity of radiotherapy for early-stage primary non-Hodgkin lymphoma of the parotid gland. Int J Radiat Oncol Biol Phys 60(5):1510–1514. https://doi.org/10.1016/j.ijrobp.2004.05.066 CrossRefPubMedGoogle Scholar
- 22.Tanvetyanon T, Qin D, Padhya T, McCaffrey J, Zhu W, Boulware D, Deconti R, Trotti A (2009) Outcomes of postoperative concurrent chemoradiotherapy for locally advanced major salivary gland carcinoma. Arch Otolaryngol Head Neck Surg 135(7):687–692. https://doi.org/10.1001/archoto.2009.70 CrossRefPubMedGoogle Scholar
- 24.National Comprehensive Cancer Network (2016) NCCN Clinical Practice Guidelines in Oncology: head and neck cancers version 2.2016Google Scholar
- 25.National Institute for Health and Care Excellence (2016) Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over (NG36)Google Scholar
- 27.Roe JWG, Carding PN, Rhys-Evans PH, Newbold KL, Harrington KJ, Nutting CM (2012) Assessment and management of dysphagia in patients with head and neck cancer who receive radiotherapy in the United Kingdom - a web-based survey. Oral Oncol 48(4):343–348. https://doi.org/10.1016/j.oraloncology.2011.11.003 CrossRefPubMedGoogle Scholar
- 29.Wall LR, Cartmill B, Ward EC, Hill AJ, Isenring E, Porceddu SV (2016) Evaluation of a weekly speech pathology/dietetic service model for providing supportive care intervention to head and neck cancer patients and their carers during (chemo)radiotherapy. Support Care Cancer 24(3):1227–1234. https://doi.org/10.1007/s00520-015-2912-5 CrossRefPubMedGoogle Scholar
- 30.Lawson N, Ward E (2014) Patient support and multidisciplinary management. In: Ward EC, van As-Brooks CJ (eds) Head and neck cancer: treatment, rehabilitation, and outcomes. vol Book, Whole, 2nd edn. Plural Publishing, San Diego, pp 447–492Google Scholar
- 31.Lawson N, Krisciunas GP, Langmore SE, Castellano K, Sokoloff W, Hayatbakhsh R (2017) Comparing dysphagia therapy in head and neck cancer patients in Australia with international healthcare systems. Int J Speech Lang Pathol 19(2):128–138. https://doi.org/10.3109/17549507.2016.1159334 CrossRefPubMedGoogle Scholar
- 32.National Cancer Institute (2009) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0Google Scholar
- 33.Trotti A, Colevas A, Setser A, Rusch V, Jaques D, Budach V, Langer C, Murphy B, Cumberlin R, Coleman C (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13(3):176–181. https://doi.org/10.1016/s1053-4296(03)00031-6 CrossRefPubMedGoogle Scholar
- 34.Gluck I, Agbulos K, Chepeha DB, Lyden T, Haxer M, Popovtzer A, Gutfeld O, Eisbruch A (2008) Validation of the Common Terminology Criteria for Adverse Events v3.0 (CTCAE) for dysphagia after chemo-radiotherapy (RT) for head and neck (HN) cancer. Int J Radiat Oncol Biol Phys 72(1):S139–S140. https://doi.org/10.1016/j.ijrobp.2008.06.457 CrossRefGoogle Scholar
- 35.Palazzi M, Tomatis S, Orlandi E, Guzzo M, Sangalli C, Potepan P, Fantini S, Bergamini C, Gavazzi C, Licitra L, Scaramellini G, Cantu G, Olmi P (2008) Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system. Int J Radiat Oncol Biol Phys 70(2):330–337. https://doi.org/10.1016/j.ijrobp.2007.06.022 CrossRefPubMedGoogle Scholar
- 36.Liu YJ, Zhu GP, Guan XY (2012) Comparison of the NCI-CTCAE version 4.0 and version 3.0 in assessing chemoradiation-induced oral mucositis for locally advanced nasopharyngeal carcinoma. Oral Oncol 48(6):554–559. https://doi.org/10.1016/j.oraloncology.2012.01.004 CrossRefPubMedGoogle Scholar
- 37.Dietitians Association of Australia, The Speech Pathology Association of Australia (2007) Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions. Nutr Diet 64:S53–S76. https://doi.org/10.1111/j.1747-0080.2007.00153.x CrossRefGoogle Scholar
- 39.Shukla RP, Dyer BA, Evangelista LM, Bewley AF, Farwell DG, Kuhn M, Belafsky P, Daly ME, Rao SSD (2017) Predicting dysphagia in patients with head and neck carcinomas treated with radiation therapy using validated swallowing metrics. Int J Radiat Oncol Biol Phys 99(2):E372–E373. https://doi.org/10.1016/j.ijrobp.2017.06.1490 CrossRefGoogle Scholar
- 40.Moroney LB, Helios J, Ward EC, Crombie J, Wockner LF, Burns CL, Spurgin A-L, Blake C, Kenny L, Hughes BGM (2017) Patterns of dysphagia and acute toxicities in patients with head and neck cancer undergoing helical IMRT ± concurrent chemotherapy. Oral Oncol 64:1–8. https://doi.org/10.1016/j.oraloncology.2016.11.009 CrossRefPubMedGoogle Scholar
- 41.Brown TE, Spurgin A-L, Ross L, Tripcony L, Keller J, Hughes BGM, Hodge R, Walker Q, Banks M, Kenny LM, Crombie J (2013) Validated swallowing and nutrition guidelines for patients with head and neck cancer: identification of high-risk patients for proactive gastrostomy. Head Neck 35(10):1385–1391. https://doi.org/10.1002/hed.23146 CrossRefPubMedGoogle Scholar
- 42.Tribius S, Sommer J, Prosch C, Bajrovic A, Muenscher A, Blessmann M, Kruell A, Petersen C, Todorovic M, Tennstedt P (2013) Xerostomia after radiotherapy. What matters--mean total dose or dose to each parotid gland? Strahlenther Onkol 189(3):216–222. https://doi.org/10.1007/s00066-012-0257-2 CrossRefPubMedGoogle Scholar
- 44.Russi EG, Corvo R, Merlotti A, Alterio D, Franco P, Pergolizzi S, De Sanctis V, Ruo Redda MG, Ricardi U, Paiar F, Bonomo P, Merlano MC, Zurlo V, Chiesa F, Sanguineti G, Bernier J (2012) Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev 38(8):1033–1049CrossRefGoogle Scholar
- 45.Moroney LB, Helios J, Ward EC, Crombie J, Pelecanos A, Burns CL, Spurgin A-L, Blake C, Chua B, Kenny L, Hughes BGM (2018) Helical IMRT with concurrent chemotherapy for oropharyngeal SCC: a prospective investigation of acute swallowing and toxicity patterns. Head Neck 00:1–12. https://doi.org/10.1002/hed.25182 CrossRefGoogle Scholar